Help

BI’s Article search uses Boolean search capabilities. If you are not familiar with these principles, here are some quick tips.

To search specifically for more than one word, put the search term in quotation marks. For example, “workers compensation”. This will limit your search to that combination of words.

To search for a combination of terms, use quotations and the & symbol. For example, “hurricane” & “loss”.

Login Register Subscribe

California workers comp case highlights independent review debate

Reprints

In Jose Dubon v. World Restoration Inc., the full California Workers' Compensation Appeals Board ruled unanimously in February that it must decide a dispute over a worker's utilization review, rather than having it decided through the independent medical review process established by California's most recent workers comp reform law.

The appeals board ruled there were “procedural defects” in a utilization review ordered by the California State Compensation Insurance Fund and that such claims can't be resolved in independent medical reviews.

An independent medical review “solely resolves disputes over the medical necessity of treatment requests,” according to the appeals board. “Issues of timeliness and compliance with statutes and regulations governing (utilization review) are legal disputes” within its jurisdiction, the appeals board ruled.

In May, the board agreed to reconsider its decision in Dubon after the state fund argued that independent medical reviews apply to “any dispute” over a workers comp review under California law. The board has not made a final ruling.

Read Next